Higher Incidence Of Constipation Research Articles

Quality of life of patients with permanent colostomy and low anterior resections (meta-analysis)

BACKGROUND: patients with rectal cancer after low anterior resections and with permanent colostomy inevitably face negative functional consequences of treatment. The question of anastomosis performing often remains unanswered. AIM: to compare the quality of life of patients with rectal cancer after low anterior resections and surgical treatment with a permanent colostomy.MATERIALS AND METHODS: literature search was performed in MEDLINE database according to PRISMA criteria using the keywords: “QoL”, “Quality of life”, “EORTC”, “low anterior resection” “rectal”, “stoma”, “ostomy” using suffixes [OR], [AND]. The meta-analysis included 9 retrospective studies with 2438 patients.RESULTS: no significant differences were found in global health status between the groups (p = 0.11). A significant difference with a worse score in ostomy patients is noted on the physical (p = 0.003), role (p = 0.002), emotional (p = 0.03) and social functioning (p = 0.004). In contrast, patients undergoing sphincter-preserving surgery have a higher incidence of constipation and diarrhea (p < 0.00001).CONCLUSION: patients with permanent stoma and after low anterior resections have comparable global health status. These patients have different profiles of disturbances in QoL patterns and functional consequences of surgery.

Incidence of opioid-induced constipation in the pediatric intensive care unit: A descriptive cohort study.

Opioid-induced constipation (OIC) is a well-known phenomenon, although there is limited literature evaluating the incidence of OIC in children admitted to the pediatric intensive care unit (PICU). The primary aim of this study was to determine the incidence of OIC in the PICU and to determine if it is associated with a higher rate of morbidities or prolonged length of stay (LOS). We conducted a single-center retrospective chart review from July 1, 2014, to June 30, 2015, in our PICU. We included all patients aged ≤18 years with a PICU stay of ≥96 h who received opioids during their admission. Data were collected on the frequency of bowel movements and characteristics of opioid administration. Demographic and clinical data were obtained from Virtual Pediatric Systems, LLC. Of the 94 patients who met the study criteria, 39.4% developed constipation. These patients tended to be older (P = 0.06) and were noted to weigh more (P = 0.03). There was no significant difference in the total or median daily doses, duration of opioid treatment, or mode of administration. Constipation rates did not differ by the severity of illness. There was a higher incidence of constipation in the patients who were admitted for neurological issues or after trauma or abdominal surgery (P = 0.002). Patients with constipation had a longer LOS than patients without constipation, but the difference was not statistically significant. These results indicate that opioid use is not the sole risk factor for constipation in the PICU setting.

DOES BOWEL FUNCTION IMPACTS ON QUALITY OF LIFE AND SEXUAL FUNCTION IN WOMEN WITH DEEP INFILTRATING ENDOMETRIOSIS ACCORDING KIND OF TREATMENT?

•Women with intestinal endometriosis may have impaired quality of life and altered bowel habits. Intestinal endometriosis can be treated medically or surgically. The bowel function of these women is directly correlated with sexual function and quality of life, regardless of the type of treatment. Background - Women with intestinal endometriosis may have a higher incidence of constipation, which may influence their quality of life. Objective - To correlate bowel function with sexual function and quality of life in women with deep endometriosis according to the type of treatment. Methods - Cross-sectional study carried out with 141 women with bowel endometriosis from May 2020 to April 2021. Women were divided into two groups according to kind of treatment: 51 women with surgery treatment and 90 women with medical treatment. The Endometriosis Health Profile Questionnaire were used to assess quality of life e Female Sexual Function Index were used to assess sexual function. To access bowel function we used the following questionnaires: Gastrointestinal Quality of Life Index and Pelvic Floor Distress Inventory. Results - The mean age of women in the surgical group (37.98±5.91years) was higher than that of the medical group (35.68±5.45years) (P=0.006). There was no statistically significant difference between pain symptoms (P=0.905), water intake (P=0.573) or fiber (P=0.173) and physical activity (P=0.792) in both groups. There was no difference between quality of life and sexual function in both groups. There was a direct correlation of bowel function with quality of life and sexual function in both groups. Conclusion: Bowel function is directly correlated with sexual function and quality of life, regardless of the type of treatment.

Translating Evidence to Practice: A Multisite Collaboration to Implement Guidelines and Improve Constipation Management in Patients With Cancer.

Despite the high incidence of constipation in people with cancer, there is little research on management strategies for opioid-induced constipation (OIC). This project used the Plan-Do-Study-Act model to examine implementation of the Oncology Nursing Society GuidelinesTM to improve constipation management in patients with cancer. Nurse champions at four sites identified practice gaps, including providing education on OIC for patients who are new to opioids and increasing follow-up assessment. This project demonstrates that multisite, collaborative projects are feasible and may enhance patient quality of life and decrease anticipated complications.

Opioid-induced constipation in intensive care – how big is the problem, and can we solve it?

Opioids are commonly used on the intensive care unit (ICU) but are associated with a high incidence of constipation, often resistant to conventional laxative treatment. Recently developed peripheral mu-opioid receptor antagonists (naloxegol, methylnaltrecone, alvimopan) are new in the treatment of

Clinical features of Parkinson disease with constipation

Objective To investigate the clinical features of Parkinson disease(PD)with constipation. Methods From October 2013 to August 2015, a total of 204 PD patients were consecutively recruited from the Departments of Geriatrics and Neurology, Beijing Tiantan Hospital, Capital Medical University, and were evaluated by Rome Ⅲ diagnostic criteria for functional constipation and other related scales of motor symptoms(MS)and non-motor symptoms(NMS), the activity of daily living(ADL)and quality of life. Results Overall, 131 of 204(64.2%)PD patients with constipation were assigned to the PD-C group and 73 of 204(35.8%)PD patients without constipation were assigned to the PD-NC group.In the PD-C group, 38 of 131(29%)PD patients had constipation before motor symptoms occurred.The mean age and age of onset in the PD-C group were significantly older than those in the PD-NC group(64.13±9.67 vs.58.35±11.37; 60.07±10.46 vs.55.10±12.97; F=2.287, 4.948; t=-3.827, -2.788; P<0.01 for both). Meanwhile, compared with the PD-NC group, the PD-C group was associated with dramatically longer disease duration(2.25, range: 1.00-5.00 vs.2.00, range: 1.00-3.13; Z=-2.254; P<0.05), increased scores of the Unified Parkinson Disease Rating Scale(UPDRS)Ⅲ(26.00 scores, range: 18.00-37.50 vs.19.00, range: 12.50-31.00; Z=-2.349, P<0.05), more advanced stages on the Hoehn-Yahr(H-Y)scale(2.00 stage, range: 1.50-2.50 vs.1.50, range: 1.00-2.50; Z=-2.334, P<0.05), higher total numbers of NMS(11.00, range: 6.00-15.00 vs.6.00, range: 3.00-11.00; Z=-3.715, P<0.05), and higher numbers of NMS occurring before and after MS(before, 2.00, range: 0.00-4.00 vs.1.00, range: 0.00-2.00; after, 8.00, range: 3.00-14.00 vs.5.00, range: 2.00-9.50; Z=-2.612, -2.630, respectively; P<0.05 for both). Additionally, there were significant differences between the groups in the scores of the Hamilton depression scale(HAMD), the Hamilton anxiety scale(HAMA), the Pittsburgh sleep quality index(PSQI), the scales for outcomes in Parkinson disease-autonomic(SCOPA-AUT), the Fatigue severity scale(FSS), the Apathy scale, the Montreal Cognitive Assessment(MoCA)scale, the UPDRSⅡ and ADL Scale, and the PDQL-39(all P<0.05). Binary Logistic regression analysis showed that age, SCOPA-AUT, HAMA and HAMD were risk factors for PD-C(OR=1.091, 1.107, 1.10 and 1.080; P<0.05 for all). Conclusions PD patients have a high incidence of constipation, and more than a quarter of patients have constipation before MS occurs.Meanwhile, PD patients with constipation are usually associated with old age and late age of onset, long disease duration, severe MS, frequent and severe NMS, bad cognition, emotional state and sleep, severe fatigue, and apathy.Moreover, advanced age, autonomic dysfunction, anxiety and depression increase the risk of PD with constipation.Constipation has a serious negative impact on the activity of daily living and quality of life in PD patients. Key words: Parkinson disease; Constipation

Is Constipation More Common in Overweight Children?

Introduction: Obesity rates have doubled in children and quadrupled in adolescents in the past 30 years. The most important causes of obesity are sedentary life style and low fiber, high calorie diet which are also putative causes of constipation. Some studies have found a correlation between constipation and obesity while others have been inconclusive. In an effort to understand this relationship we undertook a study to assess if overweight children have a higher risk of constipation as compared to normal weight children. Methods: A retrospective review of charts of new patients seen at Pediatric GI Clinic between 1/1/11 and 12/31/12 was performed. All charts were reviewed with an emphasis on growth curves and final diagnoses. Growth status of each patient was assessed by using standard WHO charts for weight, height, and body mass index (BMI) for age and sex. Obesity was defined as a BMI above 95th percentile, overweight between 85-95th percentile, normal between 3rd-85th percentile and failure to thrive (FTT) below 3rd percentile. For statistical analysis, overweight and obese patients were combined into one single group (overweight). The final diagnosis of constipation was made by the attending Pediatric Gastroenterologist. The incidences of constipation in the overweight and FTT were compared to that in normal children using chi-squared analysis. Results: Out of 1876 (M:F, 941:935) new patients seen during study period, 295 patients were overweight (M:F 146:149, 225 obese), 211 FTT and 1370 normal weight (other GI complaints/diagnoses). Observed and expected incidence of constipation in these groups is reported in Table 1. The data was analyzed by chi-squared analysis for significance of incidence of constipation in three individual categories: obese, normal, and failure to thrive (FTT). There was a higher incidence of constipation in overweight patients than expected (a chi-square value of 25. 137 and a p-value < 0.05, CI 95%). Furthermore, the data showed that the incidence of constipation was lower than expected in FTT (a chi-square value of 15.2 and a p-value < 0.05, CI 95%).Table 1: The Observed vs Expected Total Number of Constipated and Non-Constipated PatientsConclusion: There is a higher incidence of constipation in overweight children. Children with FTT have lower incidence of constipation. An analysis of nutrition and exercise habits amongst patients with constipation, obesity, overweight, and failure to thrive could further reveal associations between constipation and BMI.

Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study

Study objectiveThe study objective is to identify differences in postoperative pain management according to different analgesic treatments, targeting 2 main pathways involved in pain perception. DesignThe design is a randomized, parallel groups, open-label study. SettingThe setting is in an operating room, postoperative recovery area, and surgical ward. PatientsThere are 200 patients undergoing open inguinal hernia repair (IHR) with tension-free technique (mesh repair). InterventionsThe intervention is a randomization to receive ketorolac (group K) or tramadol (group T) for 3 days after surgery. MeasurementsThe measurements are differences in analgesic efficacy (numeric rating scale [NRS]) in the postoperative (up to 5 days) period, chronic pain incidence (1 and 3 months), side effects, and complications. Main resultsWe found no differences in analgesic efficacy (NRS value ≥4 in the first 96 hours: 26% in group K vs 32% in group T, P = .43); the proportion of patients with NRS ≥4 was similar in both groups, and the time trajectories were not significantly different (P for interaction = .24). Side effects were higher (12% vs 6%) in the tramadol group, although not significantly (P = .14), with a case of bleeding in the ketorolac group and higher incidence of constipation in tramadol group. One patient in each group developed chronic pain. ConclusionsKetorolac or weak opioids are equally effective on acute pain and on persistent postsurgical pain development after IHR, and drug choice should be based on their potential side effects and patient's comorbidities. Further studies are needed to standardize the most rational approach to prevent persistent postsurgical pain after IHR.

Association of high dietary saturated fat intake and uncontrolled diabetes with constipation: evidence from the National Health and Nutrition Examination Survey.

Constipation is highly prevalent in the United States. The association of dietary fat intake with constipation has not been well studied. We recently reported that mice fed a high-fat diet had higher incidence of constipation than regular diet fed mice. The aim of this study was to assess if increased intake of dietary saturated fat in humans is also associated with higher risk of constipation and reduced stool frequency. Analyses were based on data from 6207 adults (≥20 years) from the 2005-2006 and 2007-2008 cycles of the National Health and Nutrition Examination Surveys who had completed the bowel health questionnaire. Constipation was defined as a stool frequency of less than three times per week. Multivariable logistic regression analysis was used to calculate adjusted prevalence odds ratio (OR) estimates. Statistical analyses were performed using R and RStudio softwares. The prevalence of constipation in this sample was 3.1%. After multivariable adjustment high saturated fat remained associated with constipation. The OR for high saturated fat intake associated with constipation was much higher in diabetics above 65 years, especially in non-Hispanic blacks, females, and those with poor glycemic control, compared to the control group. To the best of our knowledge, this is the first report to investigate the association of high saturated fat diet, bowel frequency, and diabetes. This study demonstrates that a high dietary saturated fat intake is associated with significant increase in the prevalence of constipation, especially in the uncontrolled diabetic, non-Hispanic black, female patients.

Frequency, Causes, Diagnostics and Treatment of Constipation in Family Doctors Work

Constipation is a highly prevalent disorder in the primary care. The observed morbidity differences between gender, age, socioeconomic classes with different feeding habits, physical activity and related diseases. Aim. To evaluate causes, diagnostic, treatment features of constipation in the primary care. Methods: was made random interviews of people between 20-80 years old. For interview was used questionnaire of KESS (The Knowles- Eccersley- Scott- Symptom scoring system) for the diagnostic of constipation and 13 questions to assess the risks. The pilot testing of questionnaire validity was carried out, the overall Cronbach alpha coefficient is 0.978. Statistical analysis was performed using Microsoft Office Excel 2007 and SPSS 13.0 for Windows data packets. Results. Was interviewed 320 people, of which 33.13% were established constipations. The average duration of constipation ranged from 18 month up 5 years. The average age of patients with constipation was 56±14.99 years and the healthy group- 41±14.20 years (p0,05). No differences were observed between man and women (p&gt;0.05). Educational groups incidence of constipation was: high education – 29.19%, secondary – 30.3% and basic – 70.37%. We found, that most respondents eat irregularly, 3-4 times per day. We found, that increased fiber food usage, higher intake of fluid was correlated with lower incidence of constipation, as well as higher levels of physical activity or related chronic diseases (p 0.05). In assessing treatment, laxatives was used by 132 respondents, including 75.76% of patients with constipation and enemas was used by 53 respondents, including 94.43% of patients with constipation. Observed that only 62.26% of patients with constipation reported seeing a physician and 96.23% are treated independently. Conclusions: Purposefully interview of patients observed there is a high incidence of constipation. Differences of morbidity between genders are not observe, different than age and education groups. Not all investigated risk factors affect the incidence of constipation increased; mostly affects the small fluid, fiber food intake, physical activity and related chronic diseases. Patients are not give importance to this issue, and so thats why they do not seek a physician often and are treated independently.

Application of survival analysis model in predicting constipation relief in patients with thoracolumbar fractures after surgery

Objective To investigate the incidence of postoperation constipation in patients who experienced thoracolumbar fractures screw fixation surgery.Methods A prospective cohort study was performed by investigating 99 cases who experienced thoracolumbar fractures screw fixation surgery.The patients were followed up for 1 month.The postoperative constipation relief situation was observed.Kaplan-Meier method was used to draw a plot of survival,Cox proportional hazards regression model analysis was adopted for single factor and multiple factors analysis and the prediction model of constipation relief after surgery was established.Results The trend of postoperative constipation relief of patients showed a trend of first increased and then decreased,the number of cases reached high peak on the second week,the constipation relief median time was (14.00±0.76) days.Cox multiple factors regression analysis showed that prediction function model of postoperative constipation relief was h(t)=[h0(t)]e(-0.826X1+0.353X2+0.381X3-1.404X4).Conclusions There was a high incidence of constipation in patients with thora-columbar fractures after surgery and it is difficult to relieve,clinical nurses should pay more attention to the influencing factors of postoperative constipation relief and help patients reestablish normal bowel movement as soon as possible. Key words: After thoracolumbar fractures surgery; Constipation; Survival analysis model; Prediction

Análisis del estreñimiento en pacientes con traumatismo grave

ObjectivesTo evaluate the incidence and risk factors of constipation in patients with severe trauma (ST). Materials and methodA retrospective observational study (January-December 2011) of medical records in ST-patients with a minimum stay of 5 days was performed. Descriptive analysis of variables, inferential analysis: Student's T test and Chi-square of SPSS 17.0. Significance level P<.05. ResultsA total of 80 patients fulfilled the inclusion criteria, but only 69 could be analyzed. Of these, 84.06% showed constipation (according to its definition by the Work Group for Metabolism and Nutrition SEMICYUC). The most frequent day of first stool was day 7 and 9 after tolerance of enteral nutrition. Statistical significance (S.S.) of constipation was found with stay, days of sedation/relaxation/opiates, and mechanical ventilation. There was no S.S. between early enteral nutrition (EEN) and constipation (P>.05). ConclusionsThere is a very high incidence of constipation in ST patients. ICU stay, days of analgesic sedation, relaxation, and mechanical ventilation are risk factors that influence the occurrence of this problem. Laxatives should be prescribed prophylactically.

The implementation of a bowel management protocol in an adult intensive care unit

A study to explore the impact of implementing a bowel management protocol in a tertiary referral intensive care unit (ICU) in the West of Scotland. A three phase study was implemented. Phase 1 - a baseline audit reviewing 26 patients' medical notes and a baseline focus group reviewing the multidisciplinary team's (MDT's) opinions with regard to bowel care management in the ICU. Phase 2 - the implementation of a protocol, updated bowel care chart and education sessions for members of the MDT. Phase 3 - an end of study audit reviewing 27 patients' notes after the implementation of phase 2. Additionally, a further focus group examined the MDT's experiences of the protocol in clinical practice. During the phase 1 data collection period, it was evident that there was a haphazard approach to bowel care in the ICU, resulting in poor bowel care documentation and a high incidence of constipation and diarrhoea days. After the interventions of phase 2, bowel care documentation days increased by 13% (p = 0.0003), constipation incidence decreased by 20.7% (p = 0.13) and diarrhoea days reduced by 15.2% (p = 0.18). Although further evaluation is planned, the protocol implemented in this particular study appears to be a useful tool for the delivery of bowel care in the ICU. Ensuring appropriate and timely bowel care in the ICU has major implications for the critically ill patients.

半夏瀉心湯と塩酸イリノテカン併用時の便秘発現と塩酸イリノテカンの投与量

The administration of Hange-shashin-to is effective in preventing diarrhea caused by irinotecan hydrochloride (CPT-11)when they are coadministered but a high incidence of constipation has been reported when CPT-11 is used in combination with anti-diarrhea drugs.As many aspects of the occurrence of constipation with the combined use of Hange-shashin-to and CPT-11 were unclear,we decided to clarify the occurrence of constipation and its relationship with the CPT-11 dosage.To do this,we retrospectively compared two treatment groups in which Hange-shashin-to had been coadministered with CPT11 at 60 mg/m2 and 48 mg/m2,respectively.The incidence of constipation was significantly higher in the group treated with CPT-11 at 60 mg/m2 and Hange-shashin-to than that treated with CPT-11 at 48 mg/m2.These results indicate that the occurrence of constipation in such combined use is correlated not only with the CPT-11 dose but also Hange-shashin-to activity.The results also suggest that interaction between Hange-shashin-to and CPT-11 is strongly associated with the occurrence of constipation.

T1305 A Novel Type of Therapeutic Potential in a Traditional Herbal Medicine Kakkonto Against Gastrointestinal Anaphylaxis By Reducing Mucosal Mast Cell-Surface Expression of FCɛRi

Racemic verapamil, primarily a cardiovascular agent, has been widely used off-label in patients with irritable bowel syndrome (IBS). Initial observations of its usefulness followed recognition of a high incidence of constipation with use in cardiovascular conditions. The enantiomers of verapamil are known to differ in cardiovascular potency, the S-isomer being much more potent than the R-isomer. In addition we found the S-isomer to be equiactive in relaxing vascular and colonic smooth muscle but the R-isomer to be 5-times more potent in relaxing colonic than vascular muscle. This selectivity led us to develop R-verapamil (Rezular) as a gut selective treatment in IBS and we have shown doses from 60mg/day to 240mg/day to greatly improve symptoms in non-constipation IBS patients. To better understand the mechanism by which Rverapamil improved the symptoms of IBS, we undertook an in-vitro screen of binding of R-verapamil to 147 receptors/receptor sub-types. Specific ligand binding was initially assessed using 10x-5 M verapamil and if there was greater than 50% inhibition of control specific binding, then binding at 8 different concentrations was tested and IC50 values (concentration for half-maximal inhibition of control specific binding (x10 -7M)) calculated. The therapeutic plasma concentration range of free R-verapamil was conservatively set at 0.1-3x10-7 M. Within this range R-verapamil showed affinity for 3 receptors: melatonin (MT1)(IC50 0.6), 5-HT2b (IC50 1.1) and L-type calcium channel (IC50 2.4). In addition compared with S-verapamil, R-verapamil showed stereoselectivity (x40)for MT1 binding , whereas S-verapamil showed stereoselectivity (x 3)for L-type calcium channel binding. R-Verapamil was selective for 5-HT2b relative to other 5-HT receptor sub types and affinity was low for 5-HT3(IC 50 3,400) or 5-HT4(>100) receptors.It was also highly selective for MT1(IC50 0.6) versus MT2 (IC50 >100)receptors. We conclude that Rverapamil most likely exerts its therapeutic effects in IBS via a previously unrecognized mechanism involving combined effects at melatonin receptors, serotonin receptors and Ltype calcium channels.

Less nausea, emesis, and constipation comparing hydromorphone and morphine? A prospective open-labeled investigation on cancer pain

The purpose of this trial was to evaluate the effect of long-term treatment with either oral sustained-release hydromorphone (HM) or morphine (M) on nausea, emesis, and constipation. In a prospective, open-labeled, controlled trial, 100 outpatients with cancer pain and treatment with HM or M were enrolled. Mobility, pain, and gastrointestinal symptoms were assessed by the ECOG performance status, selected items of the EORTC questionnaire and Numerical Rating Scales (NRS). Data were analyzed using descriptive and confirmatory statistics (paired t-test, chi square test, Poisson regression). Demographic and medical data were comparable in both treatment groups. Taking into account different conversion factors, opioid doses (M 94.4 mg/d vs. HM 137.6 [HM/M = 1:5], p = 0.05 and HM 206.4 [HM/M = 1:7.5], p = 0.0002, respectively) were higher under hydromorphone and NRS of pain (M 2.3 vs. HM 3.6, p = 0.0002) lower under morphine. Nausea and emesis did not attenuate in 33% of patients. NRS of nausea (M 2.5 vs. HM 1.5; p = 0.01), incidences of emesis (M 0.7/d vs. HM 0.1/d, p = 0.0001), the consumption of antiemetics (M 26 vs. HM 14, p = 0.01), and the number of constipated patients (M 8 vs. HM 2, p = 0.04) were higher in the morphine group. An extended use of substances for symptom control revealed constipating effects (M 31 vs. HM 13, p = 0.0003) and was associated with a higher incidence of constipation in the morphine group. Symptom control in outpatients with cancer pain may be complicated by a symptom controlling medication. Particularly, antiemetics revealed potentially constipating effects. Despite lower opioid doses, morphine provided a better pain control but produced more side effects. Comparing hydromorphone with morphine, it remains unclear if fewer incidences of constipation and nausea in the hydromorphone group were related to pharmacodynamic effects or to a less effective pain control with significantly higher NRS for pain. However, the conversion factor of oral hydromorphone and morphine needs to be questioned.

Comparison of Oxycodone and Hydrocodone for the Treatment of Acute Pain Associated with Fractures: A Double-blind, Randomized, Controlled Trial

Background: Previous studies have demonstrated the efficacy of oxycodone and hydrocodone for the treatment of acute pain. However, to the best of the authors' knowledge, no previous reports have compared the efficacies of these commonly prescribed agents. Objectives: To compare the efficacies of oxycodone and hydrocodone for the treatment of acute pain associated with fractures in emergency department (ED) patients. Methods: This prospective, double-blind, randomized, controlled trial was conducted at an urban trauma center with an annual census of 65,000. Eligible participants included ED patients over the age of 12 years with fractures who consented to participate. Subjects were randomized to receive either oxycodone (5 mg orally [po]) with acetaminophen, or hydrocodone (5 mg po) with acetaminophen. Measurements included demographic information; pain scores on a verbal numeric rating scale at baseline and at 30 and 60 minutes; vital signs at baseline and at 30 and 60 minutes; and adverse effects. Ninety-five-percent confidence intervals (95% CIs) constructed about means and proportions were used to assess differences between the oxycodone and hydrocodone groups in analgesic efficacy and side effects. Results: Seventy-three subjects were randomized to receive oxycodone or hydrocodone. Sixty-seven subjects completed the ED study period (n= 35, oxycodone; n= 32, hydrocodone). There was no difference between the two groups in age, weight, gender, ethnicity, diagnoses, baseline pain scores, or vital signs. Patients in both groups had pain relief from baseline to 30 minutes (oxycodone mean change 3.7, 95% CI = 2.9 to 4.6; hydrocodone mean change 2.5, 95% CI = 1.7 to 3.3), and from baseline to 60 minutes (oxycodone mean change 4.4, 95% CI = 3.2 to 5.6; hydrocodone mean change 3.0, 95% CI = 2.1 to 3.9). There was no difference in pain between the patients treated with oxycodone and hydrocodone at 30 minutes (mean difference between groups −0.6, 95% CI =−1.8 to 0.5) or at 60 minutes (mean difference −0.5, 95% CI =−2.0 to 1.0). There was no difference between the groups in nausea, vomiting, itching, or drowsiness; however, the hydrocodone patients had a higher incidence of constipation (oxycodone 0%, hydrocodone 21%, difference in proportions 21%, 95% CI = 3% to 39% more with hydrocodone). Conclusions: Treatment with acetaminophen and either oxycodone, 5 mg po, or hydrocodone, 5 mg po, resulted in pain relief among ED patients with acute fractures, and there was no difference between the two agents at 30 and 60 minutes. Adverse effect profiles were similar, with the exception of a higher incidence of subsequent constipation with the use of hydrocodone. These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures.

Comparison of Oxycodone and Hydrocodone for the Treatment of Acute Pain Associated with Fractures: A Double‐blind, Randomized, Controlled Trial

Previous studies have demonstrated the efficacy of oxycodone and hydrocodone for the treatment of acute pain. However, to the best of the authors' knowledge, no previous reports have compared the efficacies of these commonly prescribed agents. To compare the efficacies of oxycodone and hydrocodone for the treatment of acute pain associated with fractures in emergency department (ED) patients. This prospective, double-blind, randomized, controlled trial was conducted at an urban trauma center with an annual census of 65,000. Eligible participants included ED patients over the age of 12 years with fractures who consented to participate. Subjects were randomized to receive either oxycodone (5 mg orally [po]) with acetaminophen, or hydrocodone (5 mg po) with acetaminophen. Measurements included demographic information; pain scores on a verbal numeric rating scale at baseline and at 30 and 60 minutes; vital signs at baseline and at 30 and 60 minutes; and adverse effects. Ninety-five-percent confidence intervals (95% CIs) constructed about means and proportions were used to assess differences between the oxycodone and hydrocodone groups in analgesic efficacy and side effects. Seventy-three subjects were randomized to receive oxycodone or hydrocodone. Sixty-seven subjects completed the ED study period (n = 35, oxycodone; n = 32, hydrocodone). There was no difference between the two groups in age, weight, gender, ethnicity, diagnoses, baseline pain scores, or vital signs. Patients in both groups had pain relief from baseline to 30 minutes (oxycodone mean change 3.7, 95% CI = 2.9 to 4.6; hydrocodone mean change 2.5, 95% CI = 1.7 to 3.3), and from baseline to 60 minutes (oxycodone mean change 4.4, 95% CI = 3.2 to 5.6; hydrocodone mean change 3.0, 95% CI = 2.1 to 3.9). There was no difference in pain between the patients treated with oxycodone and hydrocodone at 30 minutes (mean difference between groups -0.6, 95% CI = -1.8 to 0.5) or at 60 minutes (mean difference -0.5, 95% CI = -2.0 to 1.0). There was no difference between the groups in nausea, vomiting, itching, or drowsiness; however, the hydrocodone patients had a higher incidence of constipation (oxycodone 0%, hydrocodone 21%, difference in proportions 21%, 95% CI = 3% to 39% more with hydrocodone). Treatment with acetaminophen and either oxycodone, 5 mg po, or hydrocodone, 5 mg po, resulted in pain relief among ED patients with acute fractures, and there was no difference between the two agents at 30 and 60 minutes. Adverse effect profiles were similar, with the exception of a higher incidence of subsequent constipation with the use of hydrocodone. These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures.

Anorectal motility in patients with achalasia of the esophagus: recognition of an esophago-rectal syndrome.

BackgroundDuring my study of constipation, I encountered patients who had achalasia of the esophagus (AE) as well. The possibility of an existing relationship between the 2 conditions was studied.MethodInvestigations to study the anorectal motility in 9 AE patients included: the intestinal transit time, anorectal manometry, rectoanal inhibitory reflex, defecography and electromyography (EMG) of external anal sphincter and levator ani muscle. Anorectal biopsy was done. The study comprised 8 healthy volunteers as controls.Results6/9 AE patients had constipation presenting as strainodynia (excessive prolonged straining at stool). Rectocele was present in 4 of them. The 6 constipated patients showed significantly high rectal neck pressure (p < 0.05), absent rectoanal inhibitory reflex and aganglionosis in the anorectal biopsy. The EMG revealed diminished activity in 4 of the 6 constipated patients. The remaining 3 patients with AE had normal anorectal function. Heller's myotomy with Nissen's fundoplication improved the dysphagia, but not the constipation which was, however, relieved after performance of anorectal myectomy.ConclusionThe high incidence of constipation with AE postulates a relationship between the 2 conditions. Both have the same pathologic lesion which is aganglionosis. This study is preliminary and requires further studies on a larger number of patients.

Fecal Incontinence after Posterior Sagittal Anorectoplasty - Follow up of 2 years.

After an anorectal malformation (ARM) is repaired, the goal is fecal continence of the patient. Toilet training is not complete in children below 4 years of age. Manometric and radiological studies need cooperation of the child, and are therefore of little value during the critical preschool years. In this present study, we used only clinical criteria to assess the child for constipation and incontinence after definitive operation. We included all patients of ARM wef 01 April 1998 to 31 March 2000. Only 2 children had crossed 4 years of age at the time of this assessment and therefore it was not possible to assess total continence postoperatively. We found that the incidence of incontinence was less in low anomalies and more in high or intermediate anomalies, while the incidence of constipation was higher in low anomalies and less in high and intermediate anomalies. 31% of all patients born with anorectal malformations and subjected to posterior sagittal anorectoplasty (PSARP) approach were totally continent, 38% suffered with soiling of faeces while 31% had problems of constipation. The higher incidence of constipation as well as incontinence in our study is because of a short follow-up and secondly, these problems are known to improve with passage of time. The purpose of this article is to highlight the problems of bowel control even after the definitive operation and still much more is required to improve the quality of life of these unfortunate children.